R.M. Hadjal1, T. St-Laurent1,2, I. Giroux1,3
1School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
2Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, ON
3Institut du Savoir Montfort, Ottawa, ON

Primary Sclerosing Cholangitis (PSC) is a chronic autoimmune hepatic disease which involves a fibrotic inflammation of the bile ducts. Intriguingly, most PSC patients also have inflammatory bowel disease. This points to the need for more rigorous study of the intestinal environment in PSC, including an examination of the involvement of nutritional and intestinal microbiota factors.

To compile the latest literature data and themes relating nutrition and intestinal microbiota to PSC.

Primary data published between January 2001 and March 2022 relating to the general themes of nutrition, microbiota and PSC were searched in PubMed.

A total of 274 studies met the inclusion criteria with no duplicates. After title and abstract screening by two authors, 94 studies were retained. After full manuscript screening, 28 studies remained. The most common nutritional themes pertaining to the exacerbation or treatment of PSC were studies involving celiac disease (n=5), allergy (n=2), and dietary omega-3 fatty acids (n=3). As for studies also involving the intestinal microbiota, the main themes related to the exacerbation or treatment of PSC were studies describing altered microbiota composition (n=7), microbiota-derived products (n=3), and altered intestinal barrier function (n=2).

Findings suggest that celiac disease is overrepresented in the PSC patient population and could exacerbate liver damage. Omega-3 fatty acids could have beneficial effects on liver function parameters, such as alkaline phosphatase. PSC is characterized by a marked, deleterious alteration in intestinal microbiota composition and reduced intestinal barrier function.

Nutritional research in the context of PSC is scarce, but interventions targeting intestinal microbiota or intestinal barrier function, or using omega-3 fatty acids are promising avenues to pursue in the future. Nutritional interventions for intestinal disorders should be researched in the context of PSC, as they are a common comorbidity, but in this context appear to be unstudied.

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